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Bleeding and damage control surgery

Rodrigues, Roseny R.; Carmona, Maria José C.; Junior, Jose Otavio C.A.

Current Opinion in Anesthesiology: April 2016 - Volume 29 - Issue 2 - p 229–233
doi: 10.1097/ACO.0000000000000288
TRAUMA AND TRANSFUSION: Edited by Kai Zacharowski

Purpose of review Bleeding is still a major cause of death in trauma patients. Damage control surgery is a strategy that aims to control bleeding and avoid secondary contamination of the cavity. This article checks the principles and indications of damage control surgery, bleeding management, and the role of the anesthesiologist in trauma context. The efficient treatment of severe trauma and exsanguinated patients includes a surgical approach to the patient performed as quickly as possible. Volemic resuscitation, hemostatic transfusion, prevention and/or treatment of coagulopathy, hypothermia, and acidosis are strategies that reduce bleeding, as well as permissive hypotension.

Recent findings Specialized literature shows us that the adoption of all of these principles along with reduced surgical time has led to a broader concept called damage control resuscitation.

Summary Damage control resuscitation is a treatment strategy in which the recovery of physiological variables is initially prioritized over anatomical variables and can be required in severe trauma patients.

aAnesthesia and Intensive Care Department, Hospital das Clínicas

bCentral Institute, Hospital das Clínicas – São Paulo University

cHospital das Clínicas, São Paulo, Brazil

Correspondence to: Roseny R. Rodrigues, MD, PhD, Anesthesia and Intensive Care Department, Hospital das Clínicas – São Paulo University, Avenida Dr Enéas de Carvalho Aguiar, 255, São Paulo-SP, 05403-000, Brazil. Tel: +55 11 2661 6335; e-mail:

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